Provider Demographics
NPI:1033659602
Name:MAINS CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:MAINS CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:MAINS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:724-479-0988
Mailing Address - Street 1:325 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HOMER CITY
Mailing Address - State:PA
Mailing Address - Zip Code:15748-1227
Mailing Address - Country:US
Mailing Address - Phone:724-479-0988
Mailing Address - Fax:724-479-5120
Practice Address - Street 1:325 N MAIN ST
Practice Address - Street 2:
Practice Address - City:HOMER CITY
Practice Address - State:PA
Practice Address - Zip Code:15748-1227
Practice Address - Country:US
Practice Address - Phone:724-479-0988
Practice Address - Fax:724-479-5120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-02
Last Update Date:2018-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007633L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA042181Medicare PIN